May 6, 2013

Ladies—and, yes, gentlemen—are you nervous about your nipples? Anxious about your areolae? Is your left larger than your right? Is the right darker than the left? Is one too high? Is the other cracked? Or are they just too big, too bumpy, too smooth, or too small?

Increasing numbers of women and men facing these aesthetic dilemmas are turning to nipple tattoos to solve their problems. Advocates of the procedure-–which sits on the hinterland between cosmetic surgery and “semipermanent makeup,” such as eyebrow shaping—say that for some, a little judicious shading and definition of the nipple area can be a significantly cheaper and less invasive solution to chest insecurity than surgery.

But before you rush off to get your nipples tattooed, be warned: the color fades, so when you have your nice new nipples, if you want to keep them that way, you’ll have to drop into your clinic every year or two for a wee top-up.

And of course, it hardly needs to be said that you should choose with care the individual wielding a tattooists needle pricking your anaesthetized nipple and the surrounding area 100 times a second (it doesn’t hurt at the time, but it can be agony for a few days afterward).

For unfortunately, things can go wrong. “A procedure gone wrong can have devastating effects,” says one technician. “A couple of millimeters out, and those beautiful perky breasts can end up looking like you have breast-fed 15 kids.” Nipple pigmentation is not without its horror stories. And you really don’t want to end up, as one nipple tattooist says of an unfortunate client who presented at her clinic in need of a fix-up, looking like she’d put lipstick on her boobs.

These concerns have not stopped nipple tattooing—or “tittooing,” as it has inevitably become known—from becoming the fastest-growing body-alteration trend in the U.K., with plastic surgeons, beauticians, and semipermanent-makeup artists all reporting a steady uptick in the numbers of women and men seeking “nip tats” for purely cosmetic reasons, unconnected to any breast surgery.

Although nipple tattooing is for many a pure vanity exercise, the procedure has worthy roots in reconstructive surgery. After mastectomies and reconstructive breast surgery, many patients want to have the appearance of nipples restored, even if they can’t have fully functioning nipples. Artificial nipple pigmentation is also widely used to help conceal scars caused by breast enlargement or reduction and for sufferers of vitiligo. But recently there has been a surge in the numbers of men and women seeking tittoos for purely cosmetic reasons.

And what do they want done to their nipples, these seekers of a perfect chest?

They want them darker, bigger, and more symmetrical.

Nilesh Sojitra, a London plastic surgeon who is a member of the professional body the British Association of Aesthetic Plastic Surgeons, specializes in breast enlargement and reduction, but also has a nurse on hand at his clinic who performs nipple tattooing. “It is definitely getting more popular as a purely cosmetic procedure,” unconnected to any surgery, he says. “We used to get no people at all asking for it. Now it would be a few a month. There are more men asking for it also, probably 20 percent of the people we see. It is generally people who are seeing slight differences between the left and right sides and are seeking to match up. There is a question of a size and also a color match.” He adds: “It’s about looking good naked and undressing in front of their partner. When people get conscious of these things, they can think that [the imperfection] is what their partner is looking at, even if they are not.”

But surely offering clinical procedures to “color correct” and “fix” asymmetrical nipples feeds into those very insecurities rather than easing them? “We provide psychological support, and say to people, ‘You are within the normal range,’” Sojitra says. “But if it is really bothering them, it is actually a very low-risk procedure, a lunchtime thing. Nipple tattooing actually sometimes avoids surgery.”

In the U.S., one of the pioneers of nipple tattooing is Vinnie Myers, a classical tattooist who switched over from hearts and sea monsters to nipples about 12 years ago. He has performed over 4,000 nipple tattoos since then and continues to do 5 to 6 per day in Maryland and New Orleans. Myers specializes in creating “3-D nipple tattooing,” creating a nipple and areola that look like they are sticking out, but are actually drawn on flat skin, thereby avoiding the need for extra reconstruction after breast surgery.

Myers also caters to the nonsurgical market, too. “This tattooing practice has opened up other options for people wanting correction or a different look to their nipples, areolas,” he says. “Some want larger areolas. While there was some of this tattooing going on in the past, most of the time it was done by medical personnel and not traditional tattoo artists, so the results were limited. The fact that now artists are doing it, not a nurse or technician, means they look far more realistic than the salmon-colored circles of the past.”

However, others say you should run a mile from “traditional tattoo artists” and make sure instead that you are recruiting the services of a “micropigmentation specialist.”

Anouska Cassano, who has been working in micropigmentation for four years, says, “It’s actually a very different process to tattooing. Although the equipment is the same, a tattoo artist uses ink, and we use pigment. The molecule size is different—if ink were a beach ball, pigment would be a tennis ball—and pigment is designed not to be permanent.”

The nonpermanence of pigment used for nipple tattooing means retouching is needed every so often, and while that may appear an inconvenience, it is actually an advantage (not to mention a safety net), because as skin stretches and the nipple heads south over time, it can simply be redrawn and thereby retain definition like a real nipple would.

Typically, Cassano says, a client would come for two sessions to get the shade and definition of the new nipple correct—followed by top-ups at least every two years.

Cassano estimates that of the people she sees, only about 10 percent of her customers are having it as a “stand-alone treatment” unconnected to other surgery. But it is a percentage that is steadily increasing. “Not that many people know it is available. It is still not a widely known procedure.”

And what do those “cosmetic only” clients want? “Always darker and to correct what they believe is asymmetry,” she says. Does she ever worry on behalf of her clients that their quest for a perfect nipple may be a never-ending and unrealistic exercise in idle vanity?

“If people are coming to you because, for whatever reasons, they are unhappy, you need to ascertain if there is a deeper psychological issue, which means that whatever you do, they won’t be happy. Everything I do is an optical illusion. I just create an optical illusion of a perkier breast.”

Cassano adds: “I always advise that you can get darker areolae, but nothing else in life will change: the promotion at work, the husband leaving. Figuring out the person’s expectations is as important as the treatment itself.”